Dental Management of a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report
An 84-year-old woman was admitted to the emergency department after a syncope at home. At admission, her neurological status was normal, blood pressure was 200/92 mm Hg, heart rate was 90 bpm, and glycemia was 138 mg/dl. An electrocardiogram showed many ventricular ectopic beats (Figure 1). The patient experienced another syncope, and electrocardiographic monitoring suggested ventricular tachycardia or Torsades de pointes. Blood tests revealed profound hypoka lemia, alkalosis, and mild hypernatremia (Table 1).
This study was designed to identify the pathogenic mutations in two Chinese families of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) using the Whole Exome Sequencing (WES).
In a single-center study of patients with implantable cardioverter-defibrillators (ICDs) presenting with electrical storm (ES), Chatzidou et al (J Am Coll Cardiol 2018;71:1897, PMID 29699616) randomized patients to receive either propranolol (group A) or metoprolol (group B) in addition to intravenous (IV) amiodarone to assess the efficacy of treatment in terms of number and timing of subsequent arrhythmic events. ES was defined as 3 o r more episodes of either ventricular tachycardia (VT), ventricular fibrillation (VF), or both, separated by at least 5 minutes that resulted in device therapy.
Ventricular tachycardia and fibrillation are a major cause of sudden cardiac death, especially in the setting of chronic myocardial infarction (MI) . These arrhythmias are mostly based on re-entry  and depend on the combination of a trigger (usually a critically timed premature activation) and an arrhythmogenic substrate. Surviving myocardial bundles that penetrate the scar tissue form the substrate and for the basis for a long activation delays across the myocardial scar.  The site(s) where the wavefronts exit from the scar can be targeted for ablation therapy.
This patient presented with altered mental status and was thought to be intoxicated. He did not have any other apparent medical issues.I'm not certain why an ECG was recorded, but it was:The computer and the overreading physician diagnosed" Sinus rhythm with LVH. "What is it?This is an accelerated idioventricular rhythm (AIVR). There is also isorhythmic dissociation (P-waves and QRS co-incidentally going the same rate, but without the P-waves consistently conducting through the AV node because frequently the ventricular rhythm usurps it (comes too early for the P-wave to conduct).I point out the salie...
PMID: 29905367 [PubMed - in process]
We present a case of flecainide toxicity in the setting of renal impairment that was successfully treated with intravenous sodium bicarbonate. PMID: 29904301 [PubMed]
Verapamil-sensitive left fascicular monomorphic ventricular tachycardia (LF-VT) was first described ~4 decades ago. Our knowledge regarding this arrhythmia is evolving continuously. The current review aims to highlight up to date aspects of this arrhythmia focusing on its ECG recognition, new considerations of the reentrant circuit, ablation targets in inducible and non-inducible patients and the approach to LF-VT with multiform morphology.
Ablation of right-sided annular arrhythmias such as premature ventricular contractions (PVCs), ventricular tachycardia (VT), or atrioventricular bypass tracts can be challenging, with reduced efficacy related to catheter instability from annular motion and intracardiac atrial and ventricular anatomic obstacles. Enriques et al (DOI: https://doi.org/10.1016/j.hrcr.2018.02.010) presented a case series of 5 patients that highlights the use of intracardiac echocardiography (ICE) to guide ablation of right-sided annular arrhythmias.
Anna Zlotina, Artem Kiselev, Alexey Sergushichev, Elena Parmon, Anna Kostareva